Provider Demographics
NPI:1295287126
Name:SO YOUNG KWON'S PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:SO YOUNG KWON'S PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SO YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-888-1400
Mailing Address - Street 1:14242 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2435
Mailing Address - Country:US
Mailing Address - Phone:718-888-1400
Mailing Address - Fax:718-888-1404
Practice Address - Street 1:14242 41ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2435
Practice Address - Country:US
Practice Address - Phone:718-888-1400
Practice Address - Fax:718-888-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty